Provider Demographics
NPI:1700307113
Name:JACKSON, SABRINA (OWNER)
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4037 US HIGHWAY 231 STE B4037US
Mailing Address - Street 2:
Mailing Address - City:WETUMPKA
Mailing Address - State:AL
Mailing Address - Zip Code:36093-1224
Mailing Address - Country:US
Mailing Address - Phone:334-221-5051
Mailing Address - Fax:
Practice Address - Street 1:4037 US HIGHWAY 231 STE B
Practice Address - Street 2:
Practice Address - City:WETUMPKA
Practice Address - State:AL
Practice Address - Zip Code:36093-1224
Practice Address - Country:US
Practice Address - Phone:334-221-5051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-06
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide